Fuentes E, et al. - This research aspired to examine whether implementing a quality improvement project could decrease emergency department (ED) length of stay (LOS) for trauma patients requiring an ICU admission from the ED, particularly by directly admitting critically ill trauma patients from the ED CT scanner to an ICU bed. Without a change in ICU LOS, hospital LOS, or mortality, expedited admission of critically ill trauma patients immediately following CT imaging significantly reduced ED LOS by 3.82 h (229 min). To evaluate the effect of expedited admission on morbidity and mortality, further studies were needed.

• The authors performed a retrospective study comparing patients during the intervention period (2013–2014) to historical controls (2011–2013).
• They directly admitted critically ill trauma patients requiring a CT scan, but not the operating room (OR) or Interventional Radiology (IR), from the CT scanner to the ICU, termed the “One-way street (OWS)”.
• They matched controls from the 2011–2013 Trauma Registry 1:1 based on the following criteria: Injury Severity Score; mechanism of injury; and age.
• They included patients who required emergent trauma consult only.
• ED LOS, defined in minutes was the primary outcome.
• ICU LOS, hospital LOS and mortality were the secondary outcomes.
• They used paired t test or Wilcoxon signed rank test for continuous univariate analysis and Chi square for categorical variables.
• They used logistic regression and linear regressions for categorical and continuous multivariable analysis, respectively.

• The authors enrolled 110 patients, with 55 in the OWS group and 55 matched controls.
• In this study, matched controls had lower APACHE II score (12 vs. 15, p = 0.03) and a higher GCS (14 vs. 6, p = 0.04).
• In the OWS group, ED LOS was 229 min shorter (82 vs. 311 min, p < 0.0001).
• In the OWS arm, the time between CT performed and ICU disposition decreased by 230 min (30 vs. 300 min, p < 0.001).
• They found no difference in ED arrival to CT time between groups.
• Mortality was primarily predicted by the APACHE II score (OR 1.29, p < 0.001), and not ISS, mechanism of injury, or age, following multivariable analysis.
• No difference was observed in mortality between the two cohorts (OR = 0.49, p = 0.28) after controlling for APACHE II score.